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. 2012 Oct;125(10):1019-25.
doi: 10.1016/j.amjmed.2012.03.012. Epub 2012 Jul 24.

Prevalence and morbidity associated with muscle cramps in patients with cirrhosis

Hemant Chatrath  1 , Suthat Liangpunsakul, Marwan Ghabril, Julie Otte, Naga Chalasani, Raj Vuppalanchi
Affiliations

Prevalence and morbidity associated with muscle cramps in patients with cirrhosis

Hemant Chatrath et al. Am J Med. 2012 Oct.

Abstract

Purpose: Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.

Methods: A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.

Results: A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1±0.6 g/dL vs 3.3±0.7 g/dL, P=.04) and CLDQ scores (107±37 vs 137±34, P<.0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score>12). Muscle cramps (P<.001) and hepatic encephalopathy (P=.009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0±8.9 ng/mL vs 19.6±9.5 ng/mL, P=.49).

Conclusions: Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Cramp questionnaire to capture description of muscle cramps (onset, precipitating events, frequency, duration, relief, and localization) and severity of pain by visual analogue scale for pain (Wong-Baker FACES Pain Rating Scale).
Figure 2
Figure 2
Characteristics of muscle cramps as reported by the patients. A, Frequency of muscle cramps as reported by the patients (n = 101). B, Self-reported severity of cramps using visual analogue scale for pain by Wong-Baker FACES Pain Rating Scale in patients with cramps.
Figure 3
Figure 3
Significant negative correlation between the CSS and the CLDQ. CLDQ = Chronic Liver Disease Questionnaire; CSS = composite symptom score.
See this image and copyright information in PMC

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